Lumbar Vertebral Canal Research Articles

排尿障害を呈した腰椎椎間板ヘルニアの検討

Bladder dysfunction is rare, but needs urgent diagnosis and surgical treatment. At our hospital 129 cases were operated on for lumbar disc herniation over a period of two years (1993-1994) and subjects fell into two groups. Group A patients (125 cases) did not have bladder dysfunction, and Group B patients (4 cases) did. In Group B risk factors assouated with bladder dysfunction were obesity, history of lumbar ache, giant prolapsed herniation and acute worsening. Group B cases were operated on within 2 weeks (fastest 16 hours, longest 9 days since symptons occurred). Bladder dysfunction improved in all group B patients after sargery. Those operated upon sooner gained better recovery of bladder dysfunction except case 1 who had their operation the quickest, but had a poorer recovery for compared to the others. Case 1 had their prolapse at the disc between L3 and L4. The upper lumbar vertebral canal is narrow than lower, so it seems that symptoms occur more severely there. We evaluated bladder dysfunction using urinary velocity which the patient recorded. Urinary velocity was determined having patients record volume of urine over 24 hours as well as the time from start to finish of each urination.

Trefoil configuration and developmental stenosis of the lumbar vertebral canal

The midsagittal and interpedicular diameters and the trefoil shape of lumbar vertebrae of known age at death were measured in skeletons from a population aged between 1 and 70 years. All the trefoil configurations were at L5 with the exception of one at L4. The overall prevalence was 25%, but this shape was not generally apparent until adulthood. The midsagittal diameter in the trefoil canals was found to be significantly smaller than that in the unaffected canals. This did not change significantly after six years of age indicating that the cause of the trefoil configuration is probably present early in life. The trefoil shape was no more common in the spines of the elderly subjects. Our findings indicate that the trefoil configuration of the lumbar vertebral canal has a developmental origin and is not a consequence of degenerative processes.

Feline spinal lymphosarcoma: a retrospective evaluation of 23 cats.

A retrospective study of pathologically confirmed cases of feline spinal lymphosarcoma (FSL) admitted to the Colleges of Veterinary Medicine at the University of Georgia and North Carolina State University from 1973 to 1988 was conducted. Two hundred fourteen cases of feline lymphosarcoma were diagnosed histopathologically; involvement of the central nervous system (CNS) was identified in 26 (12.1%). Twenty-three of these tumors involved the spinal cord, and 22 of the 23 were solitary. A predilection for the thoracic and lumbar vertebral canal was noted. Most cats with spinal disease were young, with mean and median ages of 43 and 24 months, respectively; 67 cats were 36 months of age or younger. In most cases, affected cats had acute neurological deterioration after an initial insidious course. Extraneural abnormalities were not consistently present. Neoplastic lymphocytes diagnostic of FSL were identified on cerebrospinal fluid (CSF) analysis in 6 of 17 cats evaluated. Sixteen of 17 cats evaluated had serologically positive test results for feline leukemia virus (FeLV) p27 antigen, and all cats tested for feline immunodeficiency virus (FIV) antibodies had negative test results.

Measurements of the normal lumbar spinal canal by computed tomography

Computed tomography measurements of the main diameters and cross section areas of the lumbar vertebral canal and the lower end of the dural sac at the L3–L4 and L4–L5 levels were made in 34 young male adults who were free of symptoms. This study shows a statistically significant correlation between the height of the subject and the cross sectional area of the canal and the dural sac, and the interpedicular diameter. The determination of regression coefficients enabled an estimate to be made of the mean values of these parameters in relation to height, the actual values having a normal distribution around these means. This study suggest that the areas, when narrowing is suspected, should be interpreted as a function of the height of the subject.

Assessing the myelogram of the narrow spinal canal

The myelograms of 40 patients who had been operated on because of stenosis of the lumbar vertebral canal, were retrospectively assessed and measured. As was to be expected, the diameters were reduced, especially the sagittal diameter. Three configurations of the epidural space were seen representing different spatial capacities. The type occurring particularly often in lumbar osteogenic stenosis, which is conditioned by the patient's constitution, must be considered as a predisposing factor for the manifestation of a lumbar compression syndrome on account of its small capacity.

Zur Morphologie des lumbalen Spinalkanals

Measurements of cast preparations of epidural cavities yielded data characterising the "internal silhouette" of the lumbar vertebral canal. Three groups of different shapes of lumbar vertebral canal were found to be statistically distinguishable from each other. These are determined by the constitution of the patient. The different spatial capacity of the three types and the different relations of the diameters modify the value of the isolated determined distance, for example of the sagittal diameter at L5, which is a clinically extremely relevant factor that must be taken into account.

The Vertebral Canal

The lumbar vertebral canal was measured in adult spines from two archaeological populations, and was compared with four physiological stress indicators, (cribra orbitalia, porotic hyperostosis, dental hypoplasia and Harris lines). The stature of 38 juvenile skeletons and their canal size were compared with those of the adults. By 4 years of age the midsagittal diameter and the area of the vertebral canal was fully mature and the mean interpedicular diameter 87% of adult size. There was a differential pattern of growth, with the proximal spine maturing first. The trefoil shape was not seen at L5 before puberty. Dental hypoplasia correlated with a small interpedicular diameter at L1, L2 and L3, and Harris lines with a small midsagittal diameter at L1, L3 and L5, a small area at L5 and a more trefoil canal at L4 and L5. There is evidence that adverse environmental factors are associated with the development of spinal stenosis.

The Vertebral Canal

This study was designed to test the concept that a shallow vertebral canal in the adult may act as a marker of impaired development in early life. If that same impaired development also affected the immune and central nervous systems, there could be a relationship between the vertebral canal size, health, and academic status. A retrospective analysis was made of the general practitioner records of 94 patients, some with very narrow canals and some with wide canals. There were significantly more episodes and total attendances with infections, more episodes of low-back pain, and more attendances with trauma in those with small canals. A prospective study compared the GCE examination results of 331 children whose canals had been measured by ultrasound 3 years previously. The children in the highest three deciles for canal size performed significantly better than those in the lowest decile (P less than 0.01). There is evidence that a relation may exist between the sagittal diameter of the lumbar vertebral canal and health and academic status.

Lumbar vertebral canal morphometry for computerised tomography in spinal stenosis.

Computerised tomography is described in recent literature as a sophisticated but noninvasive technique with a particularly appropriate application in the discovery of space-occupying lesions in the lumbar vertebral canal and nerve root tunnels. Although the spinal stenosis syndrome must remain a clinical diagnosis in the first instance, computerised tomography is expected to play an increasing role in confirming the presumptive diagnosis of developmental or degenerative spinal stenosis, and in confirming the presence of a trefoil configuration or narrow lateral recess. However, the diagnosis of spinal stenosis on computerised tomography is impossible unless dimensions can be compared with established ranges of normal. The morphometry of a large sample of human skeletons of both sexes, in two race groups, and for each of the five lumbar vertebral levels, is intended to provide this information.

Spinal arachnoiditis.

A review of the literature points to the many causes of arachnoiditis and the failure of treatment to arrest or reverse its effects. The true incidence cannot be determined, although it is probably lower than might at first appear from the published articles. In the radiological literature the diagnosis seems to derive from an examination of the films alone, often without reference to the clinical findings or appearance at operation. While attempts at treatment are usually unsuccessful, some iatrogenic cases can be prevented by the avoidance of intrathecal steroid injections or unduly rough or repeated surgical exploration of the lumbar vertebral canal.

The spinal canal in familial spastic paraplegia.

The elucidation of possible involvement of the vertebral canal in familial spastic paraplegia is attempted. The sagittal and the transverse diameters of the cervical, thoracic and lumbar vertebral canal were estimated in 14 patients and 100 controls. The results showed that the vertebral canal of the patients is considerably smaller in its whole length and not only in the thoracic region. This finding is discussed in relation to the development of both the vertebral canal and spinal cord.

Stenosis of the lumbar vertebral canal and sciatica.

Stenosis of the vertebral canal is a form of compressive stenosis in contrast to transport stenosis of vessels or other channels. The concept, definition and pathomorphological properties are discussed. As it is a form of compressive stenosis, the diagnosis is based on measurements of diameters rather than of cross-sectional surfaces. The biomechanical action of compressive stenosis is compression of the fixed living content at two opposite sites or at all sites. The special properties of sciatica in stenosis are described and presented in tabular form. Some properties of neurogenic intermittent claudication (I. Cl.) in the presence of stenosis are discussed. There is a predominance of sciatica at rest and of motor weakness during walking. The mechanism of neurogenic I. Cl. is obscure. Stenosis of the lumbar vertebral canal is one of the conditional determinants of I. Cl. The data presented in this paper demonstrate, however, that stenosis is not an absolute determinant of I. Cl. and that its production depends on the combination with other determinants. The theory is advanced that other determinants may be related to changes in the caudal nerve roots due to either constitutional properties or to subclinical changes induced by ageing and chronic wear and tear, and compression and traction in the area of stenosis during various bodily activities. Suppression of sciatica during I. Cl. is a phenomenon which is particularly difficult to explain.

The trefoil configuration of the lumbar vertebral canal. A study of South African skeletal material.

The shallow lateral recesses of the trefoil shape of the lumbar spinal canal have been implicated in the production of the spinal stenosis syndrome. In the present study, 485 skeletons of South African Blacks and Whites were examined in order to establish the incidence and possible genesis of the trefoil configuration. The overall incidence was 14 per cent, with little variation between the sexes or races. The incidence was not related to increasing age, measured stenosis of the spinal canal or osteophytosis. Of 74 trefoil-shaped vertebrae, 68 (92 per cent) were found at the fifth lumbar level. It is suggested that the trefoil configuration is a common non-pathological condition, usually of the fifth lumbar vertebral canal, and is probably a developmental variation of normal anatomy.

The transverse axial tomography of the lumbar spine

This study is a preliminary report of the transverse axial tomography of the lumbar spines to evaluate them in the transverse plane.The cross section views were obtained in intraosseous and articular segments of the lumbar spinal canal at L4-S1 level in 10 normal men.We measured the transverse diameter, the sagital one and the area of the 4th and the 5th intraosseous segmats of the bony vertebral canal as follows;L4 transverse diameter 22.0mmsagital diameter 18.7mmarea 256.4mm2L5 transverse diameter 26.8mmsagital diameter 20.2mmarea 367.0 mm2ratio of L4 to L5 transverse diameter 82.5%sagital diameter 93.0% area 74.4%The shape of the bony lumbar vertebral canal was like a chestnut.

Beziehung zwischen Thermogenese im ?braunen? Fettgewebe, Temperatur im cervicalen Anteil des Vertebralkanals und K�ltezittern

Multilocular (“brown”) adipose tissue, which is found in the newborn and cold-acclimatized adult mammal, has been previously shown to be a significant site of non-shivering heat production; its interscapular and cervical portions possess a venous vascular connection to the inner vertebral sinus. As shown by the present study, the temperatures both in the cervical vertebral canal and in the interscapular adipose tissue are maintained above 39°C in the newborn guinea-pig exposed to a cold environment (16°C), whereas the temperatures drop in the hypothalamus, in the lumbar vertebral canal, and beneath the skin. Electrical activity of the sceletal musculature remained at zero level under these conditions, but oxygen uptake rose by a factor of 3.5 (non-shivering thermogenesis). After pharmacologically induced blockade of the nonshivering thermogenesis all the temperatures measured fell, and this was accompanied by onset of shivering. The same occurred in animals, 3–4 weeks of age, which had been reared in a warm environment (30°C), what has been formerly shown to lead to replacement of the brown fat by white fat. In the latter group shivering could be suppressed by moderate local rewarming of the cervical vertebral canal. Local heating of the lumbar vertebral canal and of the hypothalamus was less effective. It is concluded that shivering is suppressed in the newborn (and cold-acclimatized adult) mammal in that the temperature of thermosensitive structures in the area of the cervical vertebral canal is maintained above shivering threshold by the heat supplied from the interscapular and cervical brown adipose tissue.

A case of absolute stenosis of the lumbar vertebral canal in adults.

A discussion of developmental absolute narrowing of the lumbar vertebral canal as described byVerbiest, with particular respect to the clinical picture and the pathology has been given. A patient is described, in whom the diagnosis of abnormal narrowing of the lumbar vertebral canal had been established on the basis of the complaints and clinical symptoms, combined cisternal and lumbar fluid manometry, spinal fluid analysis, myelography and measurements of the antero-posterior diameters of the vertebral canal during operation.

Further experiences on the pathological influence of a developmental narrowness of the bony lumbar vertebral canal.

1. A measuring instrument is described which enables the surgeon to determine the anteroposterior diameter of the vertebral canal during operation. 2. Developmental narrowness of the lumbar vertebral canal is shown to exist and to be caused by an abnormally short antero-posterior diameter. 3. In patients with a narrow, although not abnormally narrow, lumbar vertebral canal, slight deformities such as posterior spur formation or small disc protrusions may produce particular symptoms, which are interesting from a clinical as well as from a medico-legal point of view.

A radicular syndrome from developmental narrowing of the lumbar vertebral canal.

1. A clinical condition is described in which there are symptoms of compression of the caudal nerve roots on standing or walking, but not at rest. Seven cases are reported. 2. Myelography showed a block in the lumbar region in every case. 3. At operation narrowing of the spinal canal in part of its lumbar course was found. 4. The nature of the abnormality is discussed. It is suggested that the narrowing is due to encroachment on the spinal canal by the articular processes.